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Home My WebLink About1101 PITCHER'S WAY - Health (2) i �o� Pars v�.y 7 No.....�Z./....... a 6 S- Fim$. .. ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH Gl ......0F.......X.. .`1 .. .... --------------.......................... b` Appliration for lhop' ial Works Towitrurtion fumit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System --. ......r-�� .................. - . ._ . ... Loca on-Address "`� or Lot No Owner Address I I aller Address Q Type of Build l r Size Lot__��//-_.1_!�?......Sq. feet a Dwelling No. of Bedrooms____________ _ Expansion Attic ( ) Garbage Grinder ( ) �_"-------•- 114 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------- - WDesign Flow_-.....................:s,,s _ gallons per person per day. Total daily flow.___..__..•.--`.. ...........gallons. WSeptic Tank� Liquid capacity_gallons Length________________ Widt ._..___. .__.__ Diameter._._______._____ Depth__.____.._..___. x Disposal Trench— 0..................... Wi, h -. -•_-_-_ ota h J=,---- -:- -- Total leaching area....................sq. ft. ?; Seepage Pit No.................... Diameter .. ..... ep Blowzl� _-_ .........__._. o al leachin area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) , ~" Percolation Test Results Performed by............................._________________ ____ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-..---_-_______-___-__-. Test Pit No. 2................minutes per inch Dept of Test Pit___._..__..___.__._. Depth to ground water........................ O Description of Soil.................... . /�� -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W •••-•---••----•--'•••-•••-••'•---•-'•-----------------------••--'-"'•.......•----'......-----•----......•--••'•'•-•-•••--•--'-"-'---•--•-----•---'•-'•'......-••"-'-'--''-•'-. UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ed by the board-L✓ealth. ' Sign ....... . . -'---"........... '-- _"""'-... Date Application Approved By'---- :.1. !} ��/'e/ ate Application Disapproved for the following reasons:............ ................... ............................................................................ -•----------•---•'•-•---.....----'•-'-•--'-'-------'----•-----------------------------------------•------ '•"•"--•••"•-----._......_...•- Date PermitNo......................................................... Issued........................................................ Date .• . -.. >< >. _..•...,.• ..... ..n. .............. .....e .................. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH �y ................OF....... �,�.,/ - ... -. ............. 'W"rrttf irate of ToutpIttturr T I. TO TIFY, That Individual wa e Disp s System nstructed (�or Repaired ( ) by ��-' . Insta ler at mil Lve-V-`' - l `�._ oc �.� = has been installed in accordance with the provisions of ,�rticle XI of he State Sanitary Code as de cribed in the application for Disposal Works Construction Permit o......................... ....... dated_..:7_/1 - ... -. .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... NO ..... 2/.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA TH r . �/... ------.OF....... .:. .. ..... :... .................. App iration for Dispus l Murks C onf- trurtion prrmft a Application is hereby°made for a Permit to Construct or Repair 4( ) an Individual Sewage Disposal System Loc on-Address or Lot N W Owner j Address a -- --- _ F-..•Te'.�._.. . ,' -�rj".-,/1..- '�•�'tom{+, 1'�.Lww............................................................ I alley Address �f .y.. Type of Build' Size Lot__5 --1 '. ......Sq. feet Dwellin Type of BB ld noms:__.. .__.--No: of persons Attic ) Garbage Grinder ( ) g P ( p I yp g p ._.. Showers ( ) — Cafeteria ( ) a' Other*fixtures W Design Flow :................... agallons per person per day. Total daily flow_._....� ......gallons. W Septic Tank -Liquid capacity,_gallons Length________________ Widt ___...._ ._... Diameter................ Depth........ ,______. x Disposal Trench— o.:............... ... Wi _ Tot h ,M,! Total leaching area....._..............sq. ft. 3 Seepage Pit No ...._:._.__ Diameter __. ep Blow i et._. ':�'_,. .....' o al leachin are ................sq. ft.. z Other Distribution box ( ) Dosingytank ( ) °. F•1 W Percolation Test Results Performed bY.................................... ....................--- .Date_....................................... Test Pit No. 1................minutes per inch Depth of Test Pit.:.................. Depth.to ground water................. 44 Test Pit No. 2...............m�iin�utesper inch Dept of Test Pit-----............... Depth to ground water............_........... P4 ------- .................... ......................................... 0 Description of Soil__... ..... tl�tr+ - y'D�":�- ------ -- U •-•••.......................................•••••.............••--------._........::......-------•-•--...........•--•----•-••-•-•--•......---------•--...--•---•---••...................................................... UNature of Repairs or Alterations—Answer when applicable._...............................................:.....:....................................... ----------------------------------•----------------------------------------------------••-------.....-----•............-----------------------------------------...------------.............---•-•...... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has been iwied by the board of health Sign -•-••- r--- ..- •....... Application Approved By... .. .. _ , .-, ate Application Disapproved for the following reasons-..............................._ •------------------•----••----------------------•-------•------------------- ......•--•-•-••----•----•-•------•....................••--•--•-•-•- Date Permit No........................ .. Issued..:-------- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... Tatifirair of Taamphaurr THIS IS TO CERTIFY, That th� Individual ewage Disp s System pristructed ( ) or Repaired ( ) by '' L ...:�.. t �--�¢ •- -c-` ----------•-•-•-----------------------------•--------- ... - Installer at......................................................................•------••-•--•--••-•---••-•-•••. has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/—)HEALTH 17 ." ...L..............OF...............! ........ .........—........................ No.......... FEE........................ 11ispnsa1 Works Taattstrud an rrT!t Permission is hereby granted........ . ... to Construct ) r Repair ( � n I di i al Sewage isp al System atNo. r E �s� r - 2{,� - -----------• -- '-- ........................... Str t " �/ as shown on the application for Disposal Works Construction P �N --•_______________ Dated.. �2f _........ 7 ----•--.--------•---------------------•--- / 1Z..V _••..-•---.--• Board of Health DATE_..._. ( ------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 3